Tips from Other Journals

Use of Colchicine in Patients with Severe Constipation

Am Fam Physician. 1999 Feb 15;59(4):975.

Constipation is the most common gastrointestinal complaint in the United States. It affects persons of all ages but is particularly troublesome in those who are elderly or disabled. Studies have shown that more than 50 percent of patients in nursing homes receive at least one laxative daily. Disabled patients may be constipated for several reasons, including autonomic dysfunction, poor oral intake, physical inactivity or as a side effect of medications. Colchicine, a medication commonly used to treat gout, is known to enhance gastrointestinal motility by neurogenic stimulation. Frame and colleagues performed a double-blind, crossover study to determine if daily administration of colchicine could improve bowel motility and reduce the need for laxatives in patients with severe constipation.

The 12 patients enrolled in the study were physically and mentally disabled adults who resided in residential care facilities and required three or more laxatives on a regular basis for more than six months. These patients had no contraindications to colchicine (specifically no hepatic or renal dysfunction). In addition, they were medically stable and had no life-threatening medical problems during the previous six months.

The trial lasted 22 weeks and was divided into four phases. During the first four weeks, the patients' laxative regimens were optimized to limit the number of doses while achieving at least three bowel movements per week. During the next eight weeks, the patients were divided into two groups: one group received oral colchicine in a dosage of 0.6 mg three times daily (or twice daily if the patient weighed less than 45 kg [99 lb]) and the second group was given an identical placebo. Phase three of the trial consisted of a two-week washout period. During phase four, the dosing was reversed, with the first group receiving placebo and the second group receiving colchicine for eight weeks. All patients were monitored clinically and by laboratory studies for any evidence of colchicine toxicity. Additional laxatives could be used as needed so that all patients would have at least three bowel movements per week. Data on the number of different laxatives and their dosages, and the frequency of bowel movements were recorded.

Eleven patients completed the study. Eight of the 11 patients experienced an increase in the number of bowel movements per week while receiving colchicine (range: three to 18). Overall, patients receiving colchicine had an average of 4.3 more bowel movements during the treatment period, a clinically, but not statistically, significant number because of the small sample size. Seven of the eight patients who had an increased number of bowel movements also required fewer doses of rectal laxatives. The colchicine was well-tolerated, with no reported incidents of nausea, vomiting, diarrhea or abdominal discomfort. Blood and stool monitoring were all within normal limits except for an elevated creatine kinase level in one patient during phase 2.

The authors conclude that colchicine apears to be a safe and effective adjunctive therapy for the management of patients with severe, intractable constipation who are resistant to standard therapies such as oral laxatives. Larger, prospective studies are needed to fully assess the long-term safety of this drug in the management of severe constipation.